Hoarding Disorder DSM-5 300.3 (F42)

DSM-5 Category: Obsessive-Compulsive and Related Disorders

Introduction.

Hoarding disorder is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders 5th ed.) diagnosis assigned to individuals who excessively save items and the idea of discarding items causes extreme stress . Hoarders cannot bear to depart from any of their belongings, which results in excessive clutter to an extent that impairs functioning and may create health and safety risks. Hoarding disorder is more than collecting a little clutter. People with Hoarding Disorder have rooms that are stacked full with items, hallways are difficult to pass through because of the amount of clutter, and sinks and tables unusable. They may come to the attention of authorities because of health and safety concerns of their homes. Hoarders are not comfortable inviting guests over and guests do not feel comfortable in the hoarders chaos.

Symptoms of Hoarding:

Symptoms of hoarding include the following;

Unable to discard possessions.

Severe anxiety over the idea of discarding possessions.

Limited living space in the home

Floor and counter space within common areas of the home (such as the kitchen and living room) are seen as storage space.

Isolation

Loneliness

Depression

Fear or embarrassment of having visitors in the home

Withdrawn

Disorganized

Indecisive about where to put things

Diagnostic Criteria for Hoarding:

Persistent difficulty or parting with possessions, regardless of their actual value.

This difficulty is due to a perceived need to save the items and to distress associated with discarding them.

The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (eg. Family members, cleaners, authorities).

The hoarding causes clinically significant distress or impairment in social, occupational or other important areas of functioning including ( including maintaining a safe environment for self and others).

The hoarding is not attributable to another medical condition (eg., brain injury, cerebrovasculat disease, Pracer-Willis syndrome).

The hoarding is not better explained by the symptoms of another mental disorder (eg. Obsessions in obsessive-compulsive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, restricted interests in autism spectrum disorder).

The hoarder engages in excessive acquisition, buys items that are unnecessary and they do not have have space for. The hoarder may have good insight and realise that their hoarding is a problem or have poor insight and not recognise their behaviour is unhealthy.
According to (DSM-5) 80-90% of hoarders also engage in excessive shopping and buying unnecessary items.

DSM-5 reports that 2% to 6% of the population have a hoarding disorder. Although hoarding is more common in older adults (55-94 years), it appears to begin at 11-15 years, and starts to cause significant impairment when people are in their 30’s (DSM-5). Hoarding is no longer considered a type of obsessive compulsive disorder (OCD), but 20 percent of people with hoarding disorder also have OCD, and are likely to collect strange objects like trash, feaces,, urine, nails, hair and rotten food (DSM-5).
Frost, Steketee, Tolin, et al, (2011) found that those diagnosed with hoarding frequently also have diagnosis of depression ( 57%), social phobia (29%), generalized anxiety disorder (28%) and attention deficit disorder. Hoarders often have tendencies towards perfectionism, indecisiveness, procrastination and difficulties planning. When people have large numbers of animals they cannot adequately care for it is referred to as animal hoarding.

Treatment For Hoarding

People with hoarding disorder are not always aware of the seriousness of their problems and only go for treatment when pressured by family or are at risk of being convicted from their home. Since hoarding can create safety and health risks harm reduction may be a main focus of treatment. A community approach to hoarding has shown positive results with helping seniors stay in their homes (Whitfield et.al., 2012). This community approach involved nurses, social workers, organisers, and support groups.
Individual treatment for a hoarder usually involves Psychotherapy and medications. A variety of therapeutic treatment options are used with hoarding. Group cognitive-behavioural therapy has shown to decrease hoarding symptoms, and symptoms of depression and anxiety (Gilliam et al., 2011). Other types of talk therapy address the cognitive and emotional challenges with hoarding behaviours, but have had less research attention. These different treatment modalities for hoarding all highlight the importance of recognizing that discarding of items may be very anxiety provoking and small, gradual steps are suggested. People hoard for different reasons and it is important to gain some understanding of the meaning of the items to people. Sometimes an overwhelming event may trigger the hoarding behaviour. The clutter may create a sense of safety, and often hoarders are trying to fill an emptiness they feel internally. The objects may have a lot of emotional meaning and letting go of items requires grieving and dealing with a loss.

Living With Hoarding

Hoarders living spaces are so cluttered that mobility and quality of life are limited. The amount of stuff takes over their homes and their lives. Friends and family members start to avoid them and hoarders sometimes out of shame isolate themselves leading to loneliness. Hoarders are not comfortable inviting guests over and guests usually feel uncomfortable in the chaos. Hoarders may not be able to sleep in their bed or cook in the kitchen. Table tops may be full of clutter and unusable. They end up feeling overwhelmed in the chaos and avoid dealing with the surmounting piles of stuff. They are unable to discern what is valuable and needed, and the thought of letting things go creates anxiety. Often the items have strong sentimental value and are a reminder of the past. They may see discarding items as wasteful or fear loosing important information. Newspapers, magazines, clothing, bags, books and paperwork are frequently saved items.
Family members may be frustrated and perplexed by the hoarders refusal to stop purchasing and inability to discard items. It is important that family members understand this is a disorder and that yelling and criticism induce shame and are unlikely to be successful in getting the hoarder to change. Hoarders may not have a lot of insight into their behaviour, and may be unaware of the thoughts and feelings that are driving their behaviours.
Health concerns may arise with unsanitary conditions and structural issues in homes. Legal and financial problems are common (Frost, Steketee & Tolin, 2011). They may come to the attention of authorities because of violating fire, health and safety regulations, which put them at risk of eviction. These challenges can motivate people to seek help. Change is always possible and most effective with the support of family, community, and a psychologist.

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